Presenting Complaints

• The patient presents with a chief complaint of blood in his urine for the past 2 weeks.

History of Presenting Complaint

• The patient first noticed bright red blood in his urine about 2 weeks ago. This has been occurring intermittently, with some days having more blood than others.
• He reports a feeling of urgency and frequency with urination, but denies any significant pain or burning.
• He has not had any fevers, chills, or back pain associated with the hematuria.
• The patient states he has been otherwise feeling well, with no recent illnesses or changes in his health.

Significant Positives & Negatives For Differentials

Kidney Stones

Positives:

• Intermittent hematuria
• No fever, chills, or back pain

Negatives:

• No history of kidney stones
• No associated flank pain

Urinary Tract Infection (UTI)

Positives:

• Urinary frequency and urgency

Negatives:

• No fever, chills
• No significant dysuria

Bladder/Kidney Cancer

Positives:

• Persistent, intermittent hematuria

Negatives:

• Relatively young patient
• No risk factors or concerning family history

Past Medical History

• Unremarkable, with no prior history of kidney stones, urinary tract infections, or other genitourinary conditions.

Drug/Medication History

• The patient takes no regular medications and denies any recent changes in his medication regimen.

Social History

• The patient is a non-smoker and does not consume alcohol regularly.
• He works as an office manager and denies any recent strenuous physical activity or trauma.
• He reports taking a trip to Spain 3 weeks ago, but has not had any gastrointestinal symptoms since returning.

Family History

• No family history of kidney stones, bladder cancer, or other urological conditions.

Systems Review

• Positive for urinary frequency and urgency.
• Negative for fever, chills, back pain, abdominal pain, nausea, vomiting, or weight changes.

Ideas, Concerns & Expectations

• The patient is concerned that the blood in his urine may be a sign of a serious underlying condition, but is hopeful that it can be easily treated.

Case Presentation

Based on the patient's presentation and the key positives and negatives for the differential diagnoses, the most likely diagnosis is a benign urological condition such as a minor bladder or kidney irritation causing the intermittent hematuria. While bladder/kidney cancer cannot be completely ruled out, the patient's age and lack of risk factors make this a less likely etiology. Further diagnostic testing is warranted to determine the underlying cause, such as urinalysis, urine culture, and potentially imaging studies (e.g. renal ultrasound, CT scan).